Australia’s National Health and Medical Research Council (NHMRC) definedcomplementary and alternative medicine (CAM) as “a wide range of health care practices, therapies, procedures and devices that are not presently considered within the domain of conventional medicine. In the Australian context CAM includes: acupuncture; aromatherapy; chiropractic; homeopathy; massage; meditation and relaxation
therapies; naturopathy; osteopathy; reflexology, traditional Chinese medicine; and the use of vitamin supplements.â€

Australians like CAM
Surveys and local research suggests that two in three Australians use CAM. Further, people spent an estimated $2.3 billion on CAM in 2000, nearly four times the public
contribution to all conventional pharmaceutical medicines.

Complementary medicine products are regulated under the Therapeutic Goods Act 1989 – The Act allows CAM manufacturers to make claims about maintaining health and well-being – but sometimes they are found to make untrue and/or misleading claims about their products to encourage people to buy them.

CAM manufacturers cannot make claims about treating an illness unless they have good-quality evidence to support the claims. But “there is often little scientific evidence to support their efficacy and few have been tested in large-scale clinical trialsâ€, a consumer representative on the Complementary Medicines Implementation Reference Group 2007 stated.

Is CAM safe?
The NHMRC is concerned about reports that people with serious, treatable conditions are using CAM that does not have strong evidence to support its use instead of evidence based treatments. An extreme example is where a complementary therapist treats a sick infant who is denied conventional medicine that could treat the infant more effectively than the complementary therapies they are given, and whose health goes from bad to worse.

The NHMRC is therefore currently reviewing CAM, commencing with homeopathy.

Many mainstream doctors prescribe metformin and aspirin. Both are conventional pharmaceutical medicines derived from plants traditionally used to treat illness. Most doctors are open to all treatment options, however I believe CAM manufacturers should
have to meet the same high standard and be held accountable in the same way as their conventional product manufacturers. Like conventional medicines, CAM should be proven to be both effective and safe before it can be sold to the public.

Lack of research evidence
However, of the many thousands of complementary medicines included on the Therapeutic Goods Administration’s list, only 200 have been independently tested for efficacy
as well as evaluated for safety and quality.

I often ask people why they take a particular CAM, and am surprised when the person says, “I don’t know whyâ€, or “Because it is good for meâ€. Few people respond in the same way when asked about conventional medicines!

Consumers need to be responsible about using CAMs effectively and safely, be able to make informed choices about CAM use, and spend their money wisely. People need
to have the skills and knowledge to do this. Think carefully about the risks and benefits before taking any medicine, conventional or complementary. The US National Centre for Complementary and Alternative Medicine provides
a balanced and unbiased source of information about CAM, as does
Australia’s Better Health Channel

The prudent approach
Very few medicines are completely free of side effects. When researching information, make sure the article is up-to-date, I looked at a variety of alternative websites. I also read the small print in several. Statements such as “This site assumes no responsibility for how this material is used†are a cause for caution. In other words, the person using CAM is responsible for what happens if they use CAM. Thus it is important to read the literature about CAM carefully. Don’t believe everything you read on the Internet.

These cautions do not mean you should not take or stop taking your CAMs, but do try to find solid evidence of their benefits and safety, and then decide whether the stated
benefits are what you are really looking for. Ask about the possible side effects and whether the CAM medicines can interact with your conventional medicines and decide
whether you want to take the risk you will experience with them. When you have this information, you can make an informed and confident decision about whether to use CAM.

Potential CAM problems
Some complementary medicines interact with conventional medicines, increasing the risk of side effects or an adverse event.

• Carefully check the contents. The Chinese herb ‘GuanMu Tong’ (Aristolochia manshuriensis) caused renal failure and death among consumers when it was mistaken by
  manufacturers for another plant and included in slimming teas
• Some herbal preparations are adulterated with conventional medicines
• Only buy CAM from reputable companies to ensure the product is manufactured according
  to regulations
• Beware of practitioners who sell you the medications they also prescribe because this
  is an obvious potential conflict of interest

If you are taking or considering taking CAM

• Make sure the problem you want to treat has been properly diagnosed/identified
• You understand the evidence on which the CAM treatment is based
• You know about possible adverse or side effects.

Aidan McElduff MBBS, PhD, FRACP is a general practitioner and member of the Conquest Editorial Advisory Panel
Professor Trisha Dunning AM, RN, PhD, MEd, FRCNA, is the Chair of Nursing at Deakin University and Barwon Health, and Vice-President of the International Diabetes Federation.

This article was originally published in Conquest Magazine published by Health Publishing Australia